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Man Up

Guys with breast cancer are more likely to die from it. Guess why.

I often joke with my wife that I'm not a lucky person. I can count
on one hand the times I've won something. But somehow, I've managed to
pull the cancer lottery and get one of the rarest forms of cancer for
men.

In November or December of 2008, I started to notice an occasional
wet spot on my shirts. For a while, I didn't think much about it. Then
I noticed that it was always the same spot. Imagine my confusion when I
realized that my right nipple was leaking a clear, serum-like
fluid.

Like many men, I rarely consult doctors. I'm on a doctor-prescribed
testosterone supplement, but generally I don't get sick, can't remember
the last time I had the flu and suffer with a cold for at most a day or
two. Typically I forego even aspirin, preferring to deal with a
headache or pain on its own terms. Plus I'd been working on losing
weight and was feeling healthy, aside from the anomaly with my right
nipple. And the seepage wasn't constant — I'd sometimes go days
without any — so I ignored it. Then one day, in March of this
year, on a whim I gave my man boob a squeeze, and it shot a stream of
liquid across the bathroom.

Time to see a doctor. He recommended further testing.

Believe me when I say that there are few things more emasculating
than being a man and having to get a mammogram. The waiting room, the
exam rooms, even the consultation rooms are all pink. They're festooned
in the ubiquitous pink imagery and ribbons of the woman's breast-cancer
movement. And here I am, a 5-foot-10, 240-pound, 38-year-old man with a
shaved head and tattoos, explaining to the young, gum-snapping female
receptionist, "No, it's not a mistake. I'm supposed to be here for a
mammogram. And thanks for letting everybody in the waiting room
know."

The mammogram was inconclusive. The radiologist was unsure about a
spider-web like mass on the right side of my chest. I saw it on the
screen, and I remember sitting there, getting that weird feeling that
things were bad. They immediately walked me over — shirtless and
wearing a paper gown made for a petite woman — to get an
ultrasound.

Afterward, I was allowed to get dressed, and I waited expectantly
for the radiologist to review the new test. After an eternally long 10
minutes, the technician came back and told me it was fine. I just had
some dilated ducts due to excess fat and it was nothing to worry about
it.

I breathed a sigh of relief and went home, happy and confident. I
was losing weight on a diet and exercise regime I'd worked out with my
regular doctor, so I figured that once I lost some more weight, the
problem would clear up on its own.

My doctor called two days later. He said the radiologist had
recommended a follow-up MRI. "They told me it was fine," I protested.
My doctor assured me it most likely was, but they were just being
thorough. "If it were me," he said, "I'd do it — although I'm
sure you have nothing to worry about."

So I went for the MRI.

At this point, my wife was getting worried and went with me. I
reassured her they'd said it was all right. I told her it was just to
be safe. I promised her it was nothing.

The day after the MRI, my doctor called back and said I needed to
get a biopsy. The mass was still hard to define and they weren't sure
what it was, but the best bet was to get a chunk of it. He was still
optimistic, but I was starting to get worried.

Two days later, I went to a pre-op appointment with the surgeon my
regular doctor had referred me to. As I walked through her door, I saw
that she was a surgical oncologist, and I found myself sitting in her
office, listening to her matter-of-factly tell me that it was a
malignancy.

"You have breast cancer," she said.

All I could focus on was a stupid pink ribbon on her wall.

Male breast cancer accounts for less than 1 percent of all
breast-cancer cases. The American Cancer Society estimates that about
1,910 new male breast-cancer cases will be diagnosed in the U.S. in
2009. About 440 will die. The mortality rate is higher for men than
women, but that's mostly attributed to the fact that men ignore
symptoms or delay treatment because of the stigma attached to what's
commonly believed to be a woman's disease.

It mostly occurs in men more than 60 years of age, but factors like
a bad liver can cause it to occur earlier. That's most likely how I got
it. The low testosterone I mention earlier could be traced back to my
liver. My doctor says it's probably genetic, but I suspect it can be
attributed to the availability of large quantities of Everclear grain
alcohol back in college. My best friend and college roommate is an
endocrinologist who matriculated at the Mayo Clinic, and he told me
that the lower testosterone may have actually opened the door to
increased estrogen.

And increased estrogen opened the door to cancer.

I learned all of this later. But I still have trouble articulating
how I felt at the moment I got the news. Numb and indifferent, I
suppose. There was a surreal quality to thinking or saying "I have
cancer." I wasn't angry. What did I have to be angry about? I don't
believe in God, so I couldn't be pissed off at him. Instead of getting
angry, or crying, or denying the obvious, I simply nodded and asked the
doctor what the next steps were. And it's been like that ever
since.

I guess I'm most affected by the fact that I now see my own
mortality. I've always seen my life in terms of the things I plan to
do. In those short few days between my diagnosis and my surgery, I
stopped thinking about things I wanted to do in some far-off future. I
found myself suddenly trapped in the swirling, curling chaos of the
present. My sense of time was restricted to the upcoming few weeks and
everything beyond that was an impenetrable darkness stretched out like
a dangerous storm cloud.

Still, my attitude was good. I found myself laughing about it and
making cancer jokes. I joked about being worried I'd lose my hair (I
have a shaved head). I joked that my fat ass and waistline could use
the slimming efficacy of a few rounds of chemo. And things weren't that
bad. Even 10 years ago, breast cancer would have been a death sentence.
Not so now. Cancer is beatable.

I found myself intentionally turning the wheel of my imagination
away from the effect my mortality will have on my two kids. We told
them that Daddy needed to have an operation — but the idea of not
being there for them the first time they get their hearts broken in
high school, or not seeing them off to college, or not attending their
weddings, or not being able to kiss the fat bellies of their own
babies, was almost more than I could bear.

So I just didn't think about it.

And I found that I needed to be strong for all of the women in my
life: my wife, my mother, my sister and even my boss. My wife had a
good attitude, although she went through crying fits at the beginning.
"It should be me," she said several times, and I assured her she was
wrong.

Once the initial shock wore off, she came around to my way of
thinking, which was that this was something to be beaten back and
bullied into submission.

Within a week I was under the knife. I had a double mastectomy and
sentinel lymph-node dissection. We decided on a double mastectomy
because I didn't want to have to deal with this on the other side
months or years later. And it didn't matter so much to me because,
unlike a woman, my breasts weren't part of my sexual identity. In fact,
I joked that I was totally getting free beer in bars for the rest of my
life. "I'll bet you a beer that I have no nipples!"

I awoke from surgery in excruciating pain. I had underestimated the
severity of the surgery and am still healing and convalescing as I
write this. I've had a few setbacks, but my oncologist has said that it
looks like they got all of the cancer. It was restricted to the tissue
in my right breast and not present in my lymph nodes or left breast. In
fact, because I'd had a double mastectomy, we removed all potentially
cancerous tissue, which means that I won't have to have
chemotherapy.

I will have to have a couple-year course of a drug called Tamoxifen,
but it is merely a preventative. It looks like the path through the
darkest part of the woods is coming to an end. But for the rest of my
life, the specter of cancer will hang ominously over me. I'll have to
endure lifelong testing and the uncertainty of my medical future. But
the path is clearing.

I was lucky. Beating situ ductal breast cancer has given me a new
perspective. I was fortunate that my body gave me enough warning signs
that I could not ignore, pushing me to see my doctor before the cancer
had spread into my pectoral muscles or my lymph nodes. The lymph nodes
are the subway system of the body and, had the cancer wound up there,
it would have metastasized and spread like, well, cancer. And
fortunately, I fought my guy-like instinct of ignoring the problem and
hoping it would go away.

And that's my reason for writing this. I feel obligated to spread
the word that male breast cancer is a real thing. If you have a man in
your life, tell him this story and encourage him to not be a dude. If
you love him, tell him to go to the doctor at the first sign of
anything weird. Tell him to quit being a tough guy.

If I'd ignored the painless, seemingly insignificant leaking from my
nipple — for even a few months — my story could have been
completely different. I could be dead.

D. Allen Crowley is an author and poet who lives in Willoughby.
His first novel North Coast Gothic: A Grim Fairy Tale, about growing up
gothic in Cleveland, was published in 2000. He also publishes a
creative blog under the pseudonym of Doctor Zombie.